A stress fracture occurs when a bone cannot respond adequately to the forces placed upon it. Normally, bones are constantly rebuilding themselves, reacting to the stresses placed on them, and producing new bone in areas of bone that have broken down. If this process becomes unbalanced, micro cracks, or “stress fractures,” can develop. A stress fracture causes a weak spot in the bone which may develop into a complete fracture.
The most common cause of stress fractures is overtraining. Stress fractures usually occur in athletes or military recruits. Training errors such as sudden increases in training intensity or duration can lead to stress fractures. Other changes in training regimens can also lead to stress fractures, including changes in shoe wear, running or training surface, and workout routines.
The main symptom of a stress fracture is pain. Typically, pain due to stress fractures gets worse with activity and is relieved by rest. There usually is a history of a recent increase in training intensity or duration. Sometimes there can also be direct tenderness on the bone. For deeper bones, pain can be elicited indirectly, such as with movement of the bone or use of the bone.
Because of the risk that a stress fracture may progress to a complete fracture, it is important to make an accurate diagnosis. It is recommended that an athlete consult a physician if there is pain with activity that does not improve with three to seven days of rest. After taking a history and performing a physical examination, the doctor will usually order an x-ray of the affected body part. Unfortunately, many stress fractures do not show up clearly on regular x-rays, and it is sometimes necessary to get further tests, such as a bone scan or an MRI.
For most stress fractures, the treatment is simply rest from activities that cause pain. In lower extremity stress fractures, cross-training with lower impact exercises such as swimming, biking, and elliptical trainer is allowed. In some cases, reducing the mileage or training on a softer surface is all that is needed. It is also important to maximize the body’s overall ability to produce healthy bone. This means proper rest, sleep, and an adequate diet which includes appropriate amounts of protein, calcium, vitamin D, and calories.
Hormonal issues are especially important in females. Overtraining and inadequate caloric intake can result in menstrual irregularities such as lack of periods. These hormonal imbalances result in a predisposition to stress fractures and difficulty in healing already established stress fractures.
In summary, it is important that stress fractures are properly recognized and treated. Ideally, it would be best to prevent stress fractures from developing in the first place. Proper nutrition and gradual and intelligent progression of physical activities are the most important factors for preventing stress fractures. One guideline is the “rule of tens”, which means that the intensity or duration of any physical activity should increase by no more than 10 % per week..
Osgood-Schlatter’s is a disorder that causes pain at the tibial tuberosity, which is the bump on the front of the knee, just below the kneecap where the patellar tendon attaches. It is generally a self-limited problem and does not lead to long-term consequences. Most athletes with Osgood-Schlatter’s will improve with a short period of rest. The problem is due to pulling of the tendon on the growth plate. Some theories of Osgood-Schlatter’s suggest that there are microfractures of the growth plate in this area.
Osgood-Schlatter’s occurs in children with open growth plates (still growing) and particularly affects active children, especially those athletes who participate in jumping or sprinting sports. Osgood- Schlatter’s is more common in boys. The growth plate is most vulnerable during periods of rapid growth and therefore the incidence in boys peaks at age 13 and at age 12 in girls. It is usually caused by overuse but can also be initiated by a sudden injury.
A physician often can simply diagnose the problem by taking a history and palpating the tender area. The knee area is tender and may be swollen or enlarged. X-rays may reveal widening of the growth plate in this area. An MRI is usually not necessary.
Activity modification is the main treatment for Osgood-Schlatter’s. Other conservative treatment measures include ice, stretching, controlled strengthening, simple over-the counter pain medicines, and a patellar strap. In more severe cases, a short period of casting or bracing may be recommended. Surgery is almost never necessary, except in adults with persistent symptoms.
The symptoms of Osgood-Schlatter’s almost always improve with rest and also usually subside when the athlete reaches skeletal maturity (fully grown). In rare cases, a fragment of bone may not unite to the underlying tibia and symptoms may persist into adulthood. In this situation, the pain can be alleviated by a simple operation to remove the fragment. Although extremely rare, an athlete who continues to play vigorous sports with persistent pain from Osgood-Schlatter’s may develop a complete fracture through the growth plate at the top of the tibia. Usually, however, the only long-term consequence of Osgood-Schlatter’s is a residual bump on the front of the knee cap which does not interfere significantly with sports..
Achy knees? Stiff fingers? Painful hips? Unfortunately, there still is no cure for arthritis. But there are plenty of steps you can take to manage the pain.
Doctors recommend several nonprescription pain relievers for arthritis. These include acetaminophen, aspirin, and ibuprofen. Glucosamine and chondroitin also can be bought without a prescription. Some studies have shown that both of these supplements may help ease the pain of osteoarthritis in knees and hips. But experts stress that more research is needed.
Heat or cold packs may offer relief. Ask your doctor what’s best for you.
EXERCISE AND WEIGHT CONTROL
Doctors recommend range-of-motion, strengthening, and aerobic exercises for arthritis sufferers. The following tips will help keep your workout safe:
• Work out when your pain is less severe and your joints are more flexible.
• Take frequent breaks, and change position regularly. Be sure to stretch muscles before and after working them.
• Ask your doctor to adjust your exercise program if you show any of the signs of too much exercise. These include increased weakness or joint swelling, unusual fatigue, decreased range of motion, or pain that lasts longer than an hour after exercising.
Another benefit of exercise for arthritis sufferers is that it helps keep weight in check. Being overweight can put extra stress on joints. Shedding excess pounds cuts down the wear and tear on joint tissues, and it also can help relieve pain and stiffness.
PROTECT YOUR JOINTS
Canes, crutches, and walkers can make walking less of a strain on your knees and hips. To protect other joints, use larger and stronger joints whenever possible. For example, carry grocery bags with your forearms or palms instead of your fingers.
From jar openers to long-handled shoehorns, many items on the market can make daily activities easier on sore joints.
Using a splint for a short time around painful joints can reduce pain and swelling. Ask your doctor if you should use one.
OTHER THERAPIES THAT MAY HELP
Many sufferers find relief by using one or more of the following measures:
• Soaking and exercising in a pool or whirlpool to cut pain and stiffness
• Relaxation therapy to release tension in muscles
• Massage therapy to increase joint motion and muscle and tendon flexibility
Ask your doctor which measures might help you. Your treatment plan should be tailored to fit your own particular symptoms..
Does your shoulder feel ‘stuck’? Is your shoulder pain so great you can barely lift your arm? Does your shoulder make even getting dressed difficult? If so, you could be suffering from adhesive capsulitis, also known as frozen shoulder.
What is Frozen Shoulder?
Frozen shoulder, also called adhesive capsulitis, is the creation of adhesions and fibrosis of the capsule of the shoulder. The capsule is the soft tissue envelope that surrounds the shoulder joint. Flexibility of the capsule is required in order for normal shoulder motion to occur. In frozen shoulder, the capsule begins to thicken and in a way, becomes vacuum sealed around the shoulder joint. This change most noticeably occurs in the inferior or bottom aspect of the capsule.
Although the creation of adhesions and fibrosis has a strong inflammatory component, there is also evidence of an autoimmune or systemic cause. People with a history of thyroid conditions and diabetes are more likely to have frozen shoulder. Adhesive capsulitis most commonly occurs between the ages of 45 and 60 and occurs more frequently in women than in men. The onset of this condition may, but generally does not, occur secondary to a trauma.
The most common signs and symptoms of adhesive capsulitis are shoulder joint pain and decreased mobility in the shoulder. The amount of pain and loss of shoulder mobility depends on the stage. There are three general stages to frozen shoulder: freezing, frozen, and thawing.
Freezing stage: generally characterized by significant joint pain and decreasing shoulder mobility. During the freezing stage, pain is the primary issue. The freezing stage can last 3 to 9 months. Pain is significant both at rest and with movement. Pain is specifically noted at night and can greatly interrupt sleep. Because the pain is so great, use of the arm becomes less for daily activities such as eating, dressing, and reaching.
Frozen stage: generally characterized by much less joint pain but significant restriction in mobility. During the frozen stage, a lack of mobility is the primary issue. This stage can last 3 to 6 months. If pain occurs during this stage it is generally not at rest but occurs with active motion. The shoulder does not feel as painful but it simply does not want to move.
Thawing stage: generally characterized by a gradual return of normal shoulder mobility. Duration of this phase is variable. Generally frozen shoulders will improve over a total of 24 months (from freezing to thawing). Minimal pain is present during this stage and over time, shoulder range of motion returns to near normal.
The emphasis for treatment is directly affected by the specific stage of the frozen shoulder.
In the freezing stage, pain reduction is of primary importance. The use of anti-inflammatory medication (consult your doctor regarding medication) as well as the use of ice therapy can help reduce the pain and inflammation. During this stage, cortisone injections can also be helpful to reduce pain and inflammation. Although performing shoulder range of motion exercises can be helpful in minimizing the loss of mobility, pain often significantly limits stretching tolerance.
During the frozen and thawing stages, stretching and mobilization of the shoulder can be beneficial in regaining shoulder mobility. Physical therapy can be helpful to manually mobilize the shoulder joint. It is important to note that the shoulder must be stretched past the point of resistance. Unfortunately this means the stretches can be rather uncomfortable. In addition, there is some evidence that longer, lower intensity stretches are more effective then short intense stretches. Because stretching can be uncomfortable and irritating, utilizing ice after stretching is recommended.
In some cases, your doctor may recommend a manipulation. With a manipulation, the shoulder joint is forcibly moved through the range of motion while you are under anesthesia. The goal is to stretch, and in some cases, tear the joint capsule. A risk to this procedure is that the capsule may not be the only tissue stretched or torn. In some cases, manipulation is a reasonable treatment option. However, recovery from a manipulation is painful and will require dedication to post-operative physical therapy stretching.
The typical physical therapy protocol for frozen shoulder will include modalities, joint mobilization, and stretching. Modalities such as ice, ultrasound, TENS, and iontophoresis can all be helpful in reducing pain. Joint mobilizations performed by the physical therapist are the means of improving mobility of the joint capsule. Although mobilizations can be uncomfortable they are vital to improving shoulder range of motion. Finally, self stretching is vitally important to regaining normal shoulder mobility. Again, because of the nature of the condition, stretching exercises will be very uncomfortable. Consistency will pay off as range of motion and functional use of your shoulder improves..
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